Types of Hearing LossTypes of Hearing Loss

Conductive Hearing LossConductive Hearing Loss

Part of ear affectedPart of ear affected: outer and/or middle: outer and/or middle

DescriptionDescription: occurs when sound cannot : occurs when sound cannot reach inner ear – in other words when reach inner ear – in other words when something prevents sound from getting something prevents sound from getting into ear into ear

Outer Ear - CausesOuter Ear - Causes

Blocked ear canalBlocked ear canalWaxWax Infection / swellingInfection / swelling

Perforated eardrumPerforated eardrumScarred / thickened Scarred / thickened

eardrumeardrumOften caused by glue Often caused by glue

earear

Middle Ear - CausesMiddle Ear - Causes

Broken ossiclesBroken ossiclesHammer, anvil, stirrupHammer, anvil, stirrup

Glue earGlue ear Infection with build up Infection with build up

of sticky fluid which of sticky fluid which prevents ossicles from prevents ossicles from vibrating properlyvibrating properly

Middle Ear - CausesMiddle Ear - Causes

Eustachian tube not Eustachian tube not opening and closing opening and closing properlyproperlyCold or catarrhCold or catarrhAllergic reactionAllergic reaction

Middle Ear - CausesMiddle Ear - Causes

OtosclerosisOtosclerosis Bony growth around Bony growth around

base of stirrup which base of stirrup which stops it from moving stops it from moving properlyproperly

Tends to run in familiesTends to run in families Often triggered by Often triggered by

pregnancy in womenpregnancy in women

Sensori-neural Hearing LossSensori-neural Hearing LossPart of ear affectedPart of ear affected: inner ear and/or : inner ear and/or

auditory nerveauditory nerve80% of people with a hearing loss have SNHL80% of people with a hearing loss have SNHL

DescriptionDescription: occurs when either the hair : occurs when either the hair cells in the cochlea and/or the nerve to the cells in the cochlea and/or the nerve to the brain are damaged and sound is not been brain are damaged and sound is not been passed onto the auditory centre in the passed onto the auditory centre in the brainbrain

Very rare that the exact cause can be Very rare that the exact cause can be identifiedidentified

The Inner EarThe Inner Ear

Cochlea

Auditory nerve

Inner Ear - CausesInner Ear - Causes

Commonest cause – old age deafness Commonest cause – old age deafness (presbyacusis)(presbyacusis)

Noise damageNoise damageVirus or infectionVirus or infectionHigh doses of some medicationsHigh doses of some medicationsChemotherapy / radiotherapy – sometimes Chemotherapy / radiotherapy – sometimes

Inner Ear - CausesInner Ear - Causes

Acoustic neuroma (benign tumour)Acoustic neuroma (benign tumour)Accident – head injuryAccident – head injuryAutoimmune Inner Ear Disease (AIED)Autoimmune Inner Ear Disease (AIED)Meniere’s DiseaseMeniere’s DiseaseCongenital Congenital

Mixed Hearing LossMixed Hearing Loss

Part of ear affectedPart of ear affected: Outer/middle and : Outer/middle and innerinner

DescriptionDescription: combination of both types of : combination of both types of hearing loss described previouslyhearing loss described previously

CausesCauses: generally more than one cause – : generally more than one cause – or conductive loss plus age-related or conductive loss plus age-related hearing loss hearing loss

Central Auditory Processing Central Auditory Processing Disorder (CAPD)Disorder (CAPD)

Part of ear affectedPart of ear affected: none: noneCaused by a difficulty in the hearing part of Caused by a difficulty in the hearing part of

the brainthe brainDescriptionDescription: occurs when sound reaches : occurs when sound reaches

brain but there is a delay / difficulty in brain but there is a delay / difficulty in identifying sound patternsidentifying sound patternsa sort of hearing dyslexiaa sort of hearing dyslexiacan be helped by lipreading as ability to can be helped by lipreading as ability to

process words is not affectedprocess words is not affected

Functional Hearing LossFunctional Hearing Loss

Persons with functional hearing loss have no physiologic Persons with functional hearing loss have no physiologic basis for a hearing deficitbasis for a hearing deficit

They are using their 'hearing loss' for secondary gain and are They are using their 'hearing loss' for secondary gain and are called called malingerersmalingerers

This is occasionally seen in adolescents or persons appying This is occasionally seen in adolescents or persons appying for pension benefits as a result of hearing lossfor pension benefits as a result of hearing loss

The apparent hearing loss is not due to a physical defect, but The apparent hearing loss is not due to a physical defect, but rather to a psychological, psychosocial, or emotional disorder rather to a psychological, psychosocial, or emotional disorder or issue. Special testing must be completed to determine if or issue. Special testing must be completed to determine if this is definitely the case. this is definitely the case.

All of the different types of hearing loss All of the different types of hearing loss

can be present at birth, i.e. congenital can be present at birth, i.e. congenital

or acquired later on in lifeor acquired later on in life

Testing the HearingTesting the Hearing

There are stages to testing the hearing:-There are stages to testing the hearing:-

1-clinical assessment of the degree of 1-clinical assessment of the degree of deafness.deafness.

2-Tunning fork tests.2-Tunning fork tests.

3-Audiometry.3-Audiometry.

4-Otoacoustic emissions .4-Otoacoustic emissions .

5-Auditory brainstem response .5-Auditory brainstem response .

1-Clinical assessment of the 1-Clinical assessment of the degree of deafness.degree of deafness.

Whispered speech test.Whispered speech test. -The GP will whisper a combination of -The GP will whisper a combination of

numbers and letters behind the patient numbers and letters behind the patient and check if he can hear anything by and check if he can hear anything by asking the patient to repeat the asking the patient to repeat the combination. combination.

- if unilateral deafness is suspected the - if unilateral deafness is suspected the good ear should be masked and the deaf good ear should be masked and the deaf ear tested.ear tested.

2-tunning fork Test.2-tunning fork Test.

There are two types of tuning fork:There are two types of tuning fork:

1-RINNE’S Test.1-RINNE’S Test.

2-WEBBER’S Test.2-WEBBER’S Test.

1-RINNE’S Test.1-RINNE’S Test.

Interpretation of Rinne’s testInterpretation of Rinne’s test

Air Conduction > Bone Conduction =Air Conduction > Bone Conduction =

normal or SNHLnormal or SNHL

• • Bone Conduction > Air Conduction = Bone Conduction > Air Conduction =

Conductive HL or dead earConductive HL or dead ear

2-WEBBER’S Test.2-WEBBER’S Test.

Interpretation of Webber’s testInterpretation of Webber’s test

In In conductive deafnessconductive deafness the sound is the sound is heard loudest in the affected ear. heard loudest in the affected ear.

In In sensorineural deafnesssensorineural deafness the sound is the sound is heard louder in the un affected ear. heard louder in the un affected ear.

3-Audiometry.3-Audiometry.

Pure tone audiometry (PTA). Pure tone audiometry (PTA). - is the key - is the key hearing test used to identify used to identify hearing

threshold levels of an individual .threshold levels of an individual .-the lower the threshold the better hearing.-the lower the threshold the better hearing.-AC threshold are obtained with headphones and -AC threshold are obtained with headphones and

measure outer , middle, inner ear and the measure outer , middle, inner ear and the auditory nerve function.auditory nerve function.

-BC threshold are obtained with bone conduction -BC threshold are obtained with bone conduction oscillators which effectively bypass outer and oscillators which effectively bypass outer and middle ear functionmiddle ear function

AUDIOGRAMAUDIOGRAM

AudiogramAudiogram

0 dB - 20 dB ....... normal hearing0 dB - 20 dB ....... normal hearing20 dB - 40 dB ..... mild hearing loss20 dB - 40 dB ..... mild hearing loss40 dB - 55 dB ..... moderate hearing loss40 dB - 55 dB ..... moderate hearing loss55 dB - 70 dB ..... moderately severe 55 dB - 70 dB ..... moderately severe

hearing losshearing loss70 dB - 90 dB ..... severe hearing loss70 dB - 90 dB ..... severe hearing loss>90 dB................. profound hearing loss>90 dB................. profound hearing loss

Audiogram – Conductive HLAudiogram – Conductive HL

- bone conduction threshold in normal - bone conduction threshold in normal rang .rang .

- air conduction threshold outside of - air conduction threshold outside of normal limits.normal limits.

- gab between AC and BC threshold > 10 - gab between AC and BC threshold > 10 db ( air bone gab ).db ( air bone gab ).

Audiogram – Conductive HLAudiogram – Conductive HL

Audiogram - SNHLAudiogram - SNHL

-both air and bone conduction threshold -both air and bone conduction threshold below normal .below normal .

-gap between AC and BC less 10 db ( no -gap between AC and BC less 10 db ( no air bone gap).air bone gap).

Audiogram - SNHLAudiogram - SNHL

4-Otoacoustic emissions 4-Otoacoustic emissions

This is used to measure the cochlear This is used to measure the cochlear function by recording signals produced by function by recording signals produced by the hair cells. the hair cells.

5-Auditory brainstem response .5-Auditory brainstem response .

This measures the activity of the cochlea, This measures the activity of the cochlea, auditory nerve and brain when a sound is auditory nerve and brain when a sound is heard. heard.

TreatmentTreatment Initial treatmentInitial treatment Treatment for Treatment for reversible reversible hearing loss depends on its cause. It is often depends on its cause. It is often

treated successfully.treated successfully. Hearing loss caused by:Hearing loss caused by: Ototoxic medicines (such as aspirin or ibuprofen) often improves after you (such as aspirin or ibuprofen) often improves after you

stop taking the medicine. stop taking the medicine. An An ear infection, such as a middle ear infection, often clears up on its own, , such as a middle ear infection, often clears up on its own,

but you may need antibiotics. but you may need antibiotics. An An injury to the ear or head you may need surgery. you may need surgery. Otosclerosis, acoustic neuroma, or Ménière's diseaseOtosclerosis, acoustic neuroma, or Ménière's disease may require may require

medicine or surgery. medicine or surgery. An An autoimmune problemautoimmune problem may be treated with corticosteroid medicines, may be treated with corticosteroid medicines,

generally prednisone. generally prednisone. Earwax is treated by removing the wax. Do not use a cotton swab or a Earwax is treated by removing the wax. Do not use a cotton swab or a

sharp object to try to remove the wax. This may push the wax even deeper sharp object to try to remove the wax. This may push the wax even deeper into the ear or may cause injury. into the ear or may cause injury.

If a If a foreign bodyforeign body is found in the ear canal, the doctor will try to take it out.  is found in the ear canal, the doctor will try to take it out.  hearing deviceshearing devices

Hearing Aid TypesHearing Aid Types

Completely In Canal (CIC)

In The Canal (ITC)

In The Ear (ITE)

Behind The Ear (BTE)

Disposable

Completely In Canal Hearing Aids (CIC)Completely In Canal Hearing Aids (CIC)

This is the smallest type of hearing aid available. All This is the smallest type of hearing aid available. All parts, including the battery, are contained in a tiny parts, including the battery, are contained in a tiny case that fits deep inside the ear canal. A thin, plastic case that fits deep inside the ear canal. A thin, plastic pull cord sticks out into the bowl-shaped area of the pull cord sticks out into the bowl-shaped area of the ear to help in removal. ear to help in removal.

The CIC aids are appropriate for Mild to Moderate The CIC aids are appropriate for Mild to Moderate hearing loss.hearing loss.

The CIC aids are NOT appropriate for infants or The CIC aids are NOT appropriate for infants or children.children.

ADVANTAGES: It is the least visible hearing aid. It ADVANTAGES: It is the least visible hearing aid. It may help reduce wind noise.may help reduce wind noise.

DISADVANTAGES: CIC aids have less space for add-DISADVANTAGES: CIC aids have less space for add-ons. Batteries are smaller, so battery life may be ons. Batteries are smaller, so battery life may be shorter. This is the most expensive type of hearing shorter. This is the most expensive type of hearing aid. This style may be difficult to handle for those with aid. This style may be difficult to handle for those with dexterity problems.dexterity problems.

Photo courtesy of

www.mayoclinic.com

In The Canal Hearing Aids (ITC)In The Canal Hearing Aids (ITC)

An ITC hearing aid fits partly in the ear canal but An ITC hearing aid fits partly in the ear canal but not as deeply as a CIC. The edge of the ITC aid not as deeply as a CIC. The edge of the ITC aid extends into the bowl of the ear.extends into the bowl of the ear.

The ITC is appropriate for Mild to The ITC is appropriate for Mild to Moderate/Severe hearing loss.Moderate/Severe hearing loss.

The ITC is NOT appropriate for infants or The ITC is NOT appropriate for infants or children.children.

ADVANTAGES: ITC aids are hardly noticeable, ADVANTAGES: ITC aids are hardly noticeable, has more opportunities for add-ons than a CIC, has more opportunities for add-ons than a CIC, and is more powerful than a CIC.and is more powerful than a CIC.

DISADVANTAGES: ITC aids can be difficult to DISADVANTAGES: ITC aids can be difficult to handle, insert, and change batteries. The ITC handle, insert, and change batteries. The ITC are also rather expensive.are also rather expensive.

Photo courtesy of

www.mayoclinic.com

In The Ear Hearing Aids (ITE)In The Ear Hearing Aids (ITE)

This style of hearing aid fills most of the This style of hearing aid fills most of the bowl-shaped portion of the ear.bowl-shaped portion of the ear.

The ITE aids are appropriate for Mild to The ITE aids are appropriate for Mild to Severe hearing loss.Severe hearing loss.

ADVANTAGES: These aids can be more ADVANTAGES: These aids can be more powerful than those that fin in the canal. The powerful than those that fin in the canal. The ITE can accommodate more add-ons. Their ITE can accommodate more add-ons. Their batteries are larger and more easily batteries are larger and more easily changed.changed.

DISADVANTAGES: ITE aids may pick up DISADVANTAGES: ITE aids may pick up more wind noise.more wind noise.

Photo courtesy of

www.mayoclinic.com

Behind The Ear Hearing Aids (BTE)Behind The Ear Hearing Aids (BTE)

BTE Aids have 2 parts. A small plastic case that rests behind the BTE Aids have 2 parts. A small plastic case that rests behind the ear contains the hearing aid circuitry: the microphone, amplifier, ear contains the hearing aid circuitry: the microphone, amplifier, and loudspeaker. The case is connected by plastic tubing to a and loudspeaker. The case is connected by plastic tubing to a custom-made earmold (earpiece) that directs the amplified sound custom-made earmold (earpiece) that directs the amplified sound into your ear. into your ear.

BTE aids are appropriate for almost all types of hearing loss and BTE aids are appropriate for almost all types of hearing loss and people of all ages.people of all ages.

BTE aids are sometimes perceived as being “old fashioned” or BTE aids are sometimes perceived as being “old fashioned” or “not technologically advanced”. But in fact, BTE aids have modern “not technologically advanced”. But in fact, BTE aids have modern electronic and digital technology like the other styles and in some electronic and digital technology like the other styles and in some cases provide the greatest improvement in hearing.cases provide the greatest improvement in hearing.

ADVANTAGES: These are the most powerful hearing aids, and ADVANTAGES: These are the most powerful hearing aids, and they can be adjusted for any degree of hearing loss. BTE aids are they can be adjusted for any degree of hearing loss. BTE aids are the best style for infants, children, and people with more severe the best style for infants, children, and people with more severe hearing loss. BTE aids are the easiest to maintain, usually require hearing loss. BTE aids are the easiest to maintain, usually require fewer repairs, and battery replacement is easier.fewer repairs, and battery replacement is easier.

DISADVANTAGES: Some people don’t have enough space DISADVANTAGES: Some people don’t have enough space between their ear and the side of their head to accommodate this between their ear and the side of their head to accommodate this style. This style may pick up more wind noise than the smaller style. This style may pick up more wind noise than the smaller aids do. aids do.

Photo courtesy of

www.mayoclinic.com

Disposable Hearing AidsDisposable Hearing Aids Disposable aids are In The Canal (ITC) hearing aids Disposable aids are In The Canal (ITC) hearing aids

designed to be worn for 40 to 70 days, then discarded.designed to be worn for 40 to 70 days, then discarded. These devices are suitable for Slight/Minimal to These devices are suitable for Slight/Minimal to

Moderate Hearing Loss.Moderate Hearing Loss. Using disposable aids may eliminate maintenance Using disposable aids may eliminate maintenance

problems due to moisture and wax buildup that occur problems due to moisture and wax buildup that occur with ongoing use of standard aids.with ongoing use of standard aids.

Disposable aids can be fitted at your hearing evaluation, Disposable aids can be fitted at your hearing evaluation, so you can leave wearing your new hearing aid. so you can leave wearing your new hearing aid. However, disposable aids will not fit everyone’s ears or However, disposable aids will not fit everyone’s ears or meet everyone’s needs.meet everyone’s needs.

ADVANTAGES: Disposable aids require minimal ADVANTAGES: Disposable aids require minimal maintenance. You cn receive them at the time of your maintenance. You cn receive them at the time of your hearing evaluation.hearing evaluation.

DISADVANTAGES: These aids are not custom fit, and DISADVANTAGES: These aids are not custom fit, and may not fit everyone comfortably. They have less may not fit everyone comfortably. They have less adjustable circuitry and no special features. Also, there adjustable circuitry and no special features. Also, there is the ongoing expense of buying a new one every two is the ongoing expense of buying a new one every two months.months. Photo courtesy of

www.cicoil.com

Implantable Hearing AidImplantable Hearing Aid Implantable hearing aids are an Implantable hearing aids are an

alternative to traditional hearing alternative to traditional hearing aids for people with Moderate to aids for people with Moderate to Severe Sensorineural Hearing Severe Sensorineural Hearing Loss.Loss.

Implantable hearing aids conduct Implantable hearing aids conduct sound by vibrating the middle ear sound by vibrating the middle ear bones directly to stimulate the bones directly to stimulate the inner ear.inner ear.

This device is NOT recommended This device is NOT recommended for those with Conductive Hearing for those with Conductive Hearing Loss.Loss.

A wire leads from the receiver to A wire leads from the receiver to the electromagnet attached to one the electromagnet attached to one of the middle ear bones. Some of the middle ear bones. Some styles have the receiver surgically styles have the receiver surgically implanted into the skull behind the implanted into the skull behind the ear with an external amplifier. ear with an external amplifier. Other styles have the receiver and Other styles have the receiver and amplifier in an external processor amplifier in an external processor worn behind the ear.worn behind the ear.

Photo courtesy of Microtia Australia Vibrant Soundbridge via http://microtiaaustralia.org.au

ADVANTAGES: These devices may produce a more natural sound and are more versatile for sporting activities such as swimming.

DISADVANTAGES: Implantable aids require surgery, and can cost from $6,000 to $18,000 depending on which device is selected and which type of anesthesia is necessary.

Cochlear ImplantCochlear Implant

Cochlear implants are not an alternative Cochlear implants are not an alternative to hearing aids.to hearing aids.

These devices are designed for These devices are designed for individuals who receive little to no help individuals who receive little to no help from hearing aids.from hearing aids.

Candidates for cochlear implants typically Candidates for cochlear implants typically have severe to profound sensorineural have severe to profound sensorineural hearing loss in both ears or have great hearing loss in both ears or have great difficulty understanding speech.difficulty understanding speech.

Children as young as 1 year old can Children as young as 1 year old can receive the implant, and there is no upper receive the implant, and there is no upper age limit. age limit.

ADVANTAGES: Many insurance ADVANTAGES: Many insurance companies cover cochlear implants which companies cover cochlear implants which greatly reduces the cost to the patient.greatly reduces the cost to the patient.

►DISADVANTAGES: There is a lot DISADVANTAGES: There is a lot of follow-up and programming that of follow-up and programming that must be done after the surgery. must be done after the surgery. This is a time-commitment that This is a time-commitment that some people do not want. The some people do not want. The surgery and all the pre and post surgery and all the pre and post operative requirements can cost operative requirements can cost between $30,000 and $50,000. between $30,000 and $50,000. That can be very costly if your That can be very costly if your insurance does not cover 100% of insurance does not cover 100% of the procedure.the procedure.

A A cochlear implantcochlear implant

is a surgically implanted electronic device is a surgically implanted electronic device that provides a sense of sound to a person that provides a sense of sound to a person who is profoundly deaf or severely hard of who is profoundly deaf or severely hard of hearing. hearing.

For children and adults who derive noFor children and adults who derive no

benefit from the use of properly fittedbenefit from the use of properly fitted

hearing aidshearing aids

Cochlear ImplantsCochlear Implants

THANK YOUTHANK YOU